What is pantoprazole sod dr 40 mg used for. Pantoprazole: A Comprehensive Guide to Usage, Dosage, and Side Effects
What is pantoprazole used for. How does pantoprazole work. What are the key facts about pantoprazole. Who can take pantoprazole. How should pantoprazole be taken. What are the potential side effects of pantoprazole. How does pantoprazole compare to other acid-reducing medications.
Understanding Pantoprazole: An Effective Acid-Reducing Medication
Pantoprazole is a widely prescribed medication that belongs to a class of drugs known as proton pump inhibitors (PPIs). Its primary function is to reduce the amount of acid produced by the stomach, making it an effective treatment for various gastrointestinal conditions.
Why is pantoprazole prescribed? Doctors commonly recommend pantoprazole for:
- Heartburn
- Acid reflux
- Gastro-oesophageal reflux disease (GORD)
- Prevention and treatment of stomach ulcers
- Zollinger-Ellison syndrome (a rare condition caused by tumors in the pancreas or gut)
How does pantoprazole work? It inhibits the proton pumps in the stomach lining, which are responsible for producing stomach acid. By reducing acid production, pantoprazole helps alleviate symptoms associated with excessive stomach acid and allows damaged tissues to heal.
Key Facts About Pantoprazole: Dosage and Administration
What is the typical dosage for pantoprazole? The standard dose is usually taken once daily in the morning. However, dosages can vary depending on the condition being treated:
- Heartburn and acid reflux: 20mg daily
- GORD: 20mg to 40mg daily
- Stomach ulcers: 20mg to 40mg daily
- Zollinger-Ellison syndrome: 40mg to 80mg daily, potentially increasing to 160mg daily based on response
How quickly does pantoprazole take effect? Most patients begin to experience relief within 2 to 3 days of starting treatment. However, it may take up to 4 weeks for pantoprazole to fully control symptoms in some cases.
Can pantoprazole be purchased over-the-counter? Lower-strength 20mg tablets are available without a prescription for short-term treatment of heartburn and acid reflux. However, it’s important to consult a doctor if symptoms persist after 2 weeks of self-treatment.
Who Can Take Pantoprazole? Suitability and Precautions
Is pantoprazole suitable for everyone? While pantoprazole is generally safe for most adults and children over 12 years old, certain individuals should exercise caution or avoid its use:
- Those with a history of allergic reactions to pantoprazole or other medications
- Individuals with liver problems
- Pregnant or breastfeeding women
- Patients scheduled for an endoscopy
Why might pantoprazole interfere with endoscopy results? Pantoprazole can mask certain issues that would typically be visible during an endoscopy. For this reason, doctors may advise stopping pantoprazole treatment a few weeks before the procedure.
Pregnancy and Pantoprazole Use
Is pantoprazole safe during pregnancy? Generally, pantoprazole is not recommended during pregnancy unless deemed absolutely necessary by a healthcare provider. The potential risks to the developing fetus must be weighed against the benefits of treatment for the mother.
Proper Administration of Pantoprazole: Timing and Method
When is the best time to take pantoprazole? For optimal effectiveness, pantoprazole should be taken an hour before a meal. This timing allows the medication to be absorbed and start working before food stimulates acid production in the stomach.
How should pantoprazole tablets be taken? Swallow the tablets whole with a glass of water. Do not crush, chew, or break the tablets, as this can affect their efficacy.
Missed Doses and Overdose
What should you do if you miss a dose of pantoprazole? If you typically take pantoprazole once daily and miss a dose, take it as soon as you remember, unless your next scheduled dose is less than 12 hours away. For twice-daily regimens, take the missed dose if it’s within 4 hours of the scheduled time; otherwise, skip it and continue with your regular dosing schedule.
Is an overdose of pantoprazole dangerous? While taking extra doses of pantoprazole is unlikely to cause serious problems, it’s always best to consult a healthcare provider if you’re concerned about potential overdose.
Side Effects of Pantoprazole: What to Expect and When to Seek Help
What are the most common side effects of pantoprazole? The majority of people tolerate pantoprazole well, but some may experience mild side effects such as:
- Headaches
- Diarrhea
- Stomach pain
- Feeling sick
- Constipation
- Wind
- Dizziness
- Dry mouth
These side effects are typically mild and often subside as your body adjusts to the medication. However, if they persist or worsen, it’s advisable to consult your healthcare provider.
Serious Side Effects and Allergic Reactions
When should you seek immediate medical attention while taking pantoprazole? Although rare, some individuals may experience serious side effects or allergic reactions. Seek immediate medical help if you experience:
- Joint pain accompanied by a red skin rash, especially in areas exposed to the sun
- Yellow skin or eyes (jaundice), which may indicate liver problems
- Severe stomach pain or persistent changes in bowel habits
- Signs of an allergic reaction, such as difficulty breathing, swelling of the face, lips, tongue, or throat
Long-Term Use of Pantoprazole: Benefits and Considerations
Is it safe to take pantoprazole long-term? While pantoprazole is generally considered safe for long-term use, prolonged use may be associated with certain risks. These can include:
- Increased risk of bone fractures, particularly in older adults
- Vitamin B12 deficiency
- Increased risk of certain infections, such as Clostridium difficile
- Potential interference with the absorption of certain minerals and medications
How can these risks be mitigated? Regular check-ups with your healthcare provider, periodic blood tests to monitor vitamin and mineral levels, and discussing any concerns or new symptoms can help manage the potential risks associated with long-term pantoprazole use.
Tapering Off Pantoprazole
Should pantoprazole be stopped abruptly or gradually? If you’ve been taking pantoprazole for an extended period, it’s generally recommended to taper off the medication gradually rather than stopping abruptly. This can help prevent a rebound increase in stomach acid production.
Pantoprazole vs. Other Acid-Reducing Medications: A Comparison
How does pantoprazole compare to other proton pump inhibitors? Pantoprazole is one of several PPIs available, including omeprazole, esomeprazole, and lansoprazole. While they all work similarly, some differences may make one more suitable than another for certain individuals:
- Pantoprazole may have fewer drug interactions compared to some other PPIs
- It may be more effective in maintaining symptom relief in some patients with GORD
- Some studies suggest pantoprazole may have a lower risk of certain side effects compared to other PPIs
How do PPIs like pantoprazole differ from H2 blockers? H2 blockers (such as ranitidine and famotidine) work by blocking histamine receptors in the stomach, which also reduces acid production. However, PPIs like pantoprazole are generally more effective at reducing acid production and healing damaged esophageal tissue in conditions like GORD.
Choosing the Right Acid-Reducing Medication
What factors should be considered when choosing between pantoprazole and other acid-reducing medications? The choice between pantoprazole and other medications depends on several factors:
- The specific condition being treated
- The severity of symptoms
- Individual response to treatment
- Potential drug interactions with other medications
- Cost and insurance coverage
Always consult with a healthcare provider to determine the most appropriate treatment option for your specific situation.
Lifestyle Modifications to Complement Pantoprazole Treatment
While pantoprazole can effectively reduce stomach acid, certain lifestyle changes can complement its effects and help manage symptoms. Consider incorporating the following strategies:
- Avoid trigger foods that exacerbate acid reflux (e.g., spicy, fatty, or acidic foods)
- Eat smaller, more frequent meals rather than large meals
- Avoid lying down immediately after eating
- Elevate the head of your bed to reduce nighttime reflux
- Quit smoking and limit alcohol consumption
- Maintain a healthy weight
- Manage stress through relaxation techniques or exercise
How can these lifestyle changes enhance the effectiveness of pantoprazole? By reducing factors that contribute to acid reflux and GORD, these modifications can help pantoprazole work more effectively, potentially allowing for lower doses or shorter treatment durations.
Natural Remedies and Pantoprazole
Can natural remedies be used alongside pantoprazole? Some individuals find relief from acid-related symptoms through natural remedies such as:
- Ginger tea
- Chamomile tea
- Aloe vera juice
- Deglycyrrhizinated licorice (DGL)
- Probiotics
While these remedies may provide additional relief, it’s important to consult with a healthcare provider before combining them with pantoprazole to ensure there are no potential interactions or contraindications.
Monitoring and Follow-Up: Ensuring Optimal Treatment with Pantoprazole
Regular monitoring is crucial for individuals taking pantoprazole, especially those on long-term treatment. This may include:
- Periodic assessment of symptoms and treatment effectiveness
- Blood tests to check vitamin B12 and magnesium levels
- Bone density scans for those at risk of osteoporosis
- Endoscopy to evaluate healing of esophageal or stomach tissue
How often should follow-up appointments be scheduled? The frequency of follow-up appointments will depend on individual circumstances, but generally, patients on long-term pantoprazole treatment should have at least annual check-ups with their healthcare provider.
Adjusting Treatment Over Time
Is it necessary to continue pantoprazole indefinitely? For some conditions, such as severe GORD or Zollinger-Ellison syndrome, long-term treatment may be necessary. However, for many individuals, it may be possible to reduce the dose or frequency of pantoprazole over time as symptoms improve.
How can treatment be adjusted safely? Any changes to pantoprazole treatment should be made under the guidance of a healthcare provider. They may recommend:
- Gradual dose reduction
- Switching to on-demand therapy (taking pantoprazole only when symptoms occur)
- Transitioning to a different class of medication, such as H2 blockers
- Discontinuing medication if symptoms have resolved and lifestyle modifications are sufficient
By working closely with your healthcare provider and maintaining open communication about your symptoms and concerns, you can ensure that your pantoprazole treatment remains optimized for your individual needs over time.
Pantoprazole: medicine to lower stomach acid
1. About pantoprazole
Pantoprazole reduces the amount of acid your stomach makes.
It’s used for heartburn, acid reflux and gastro-oesophageal reflux disease (GORD) – GORD is when you keep getting acid reflux. It’s also taken to prevent and treat stomach ulcers.
Sometimes, pantoprazole is taken for a rare condition caused by a tumour in the pancreas or gut called Zollinger-Ellison syndrome.
Pantoprazole comes as tablets.
All types of pantoprazole are available on prescription. You can also buy lower-strength 20mg tablets from pharmacies for heartburn or acid reflux.
2. Key facts
- You’ll usually take pantoprazole once a day in the morning.
- The most common side effects are headaches and diarrhoea.
These tend to be mild and go away when you stop taking the medicine.
- You should start to feel better in 2 to 3 days, but it may take up to 4 weeks for pantoprazole to fully control your symptoms.
- If you’ve bought pantoprazole without a prescription and your symptoms do not improve after 2 weeks, see a doctor before taking any more.
- Pantoprazole is not usually recommended during pregnancy.
3. Who can and cannot take pantoprazole
Adults and children aged 12 years and over can take pantoprazole.
Pantoprazole is not suitable for some people. To make sure it’s safe for you, tell your doctor if you:
- have ever had an allergic reaction to pantoprazole or any other medicine
- have liver problems
- are pregnant, trying to get pregnant or breastfeeding
- are due to have an endoscopy
If you’re going to have an endoscopy, ask your doctor if you should stop taking pantoprazole a few weeks before your procedure. This is because pantoprazole may hide some of the problems that would usually be spotted during an endoscopy.
4. How and when to take pantoprazole
You’ll usually take pantoprazole once a day, first thing in the morning.
If you take pantoprazole twice a day, take 1 dose in the morning and 1 dose in the evening.
Dosage and strength
Each tablet contains 20mg or 40mg of pantoprazole.
You can buy pantoprazole 20mg tablets from pharmacies. These are suitable for the short-term treatment of heartburn and acid reflux in adults.
The usual dose to treat:
- heartburn and acid reflux is 20mg a day
- gastro-oesophageal reflux disease is 20mg to 40mg a day
- stomach ulcers is 20mg to 40mg a day
- Zollinger-Ellison syndrome is 40mg to 80mg a day – this can increase to 160mg a day depending on how well it works for you
Doses are usually lower for people with liver problems.
How to take it
It’s best to take pantoprazole an hour before a meal. Swallow tablets whole with a drink of water.
Changes to your dose
Sometimes your doctor will increase your dose of pantoprazole if it’s not working well enough.
Depending on the reason you take pantoprazole, you may take a higher dose to begin with, usually for a month or 2. After this, your doctor may recommend that you take a lower dose.
How long to take it for
If you buy pantoprazole from a pharmacy, you can usually take it for up to 2 weeks.
After 2 weeks:
- if your symptoms have improved, you can take it for another 2 weeks
- if your symptoms have not improved or they are worse, speak to a doctor before taking any more pantoprazole
Do not take pantoprazole for more than 4 weeks without speaking to your doctor first. If your symptoms have not improved, you may need some tests to find out what’s causing them.
If you take pantoprazole on prescription, you may only need to take it for a few weeks or months, depending on your condition. Sometimes your doctor may advise you to take it for longer, even for many years.
Some people do not need to take pantoprazole every day and take it only when they have symptoms. Once you feel better (often after a few days or weeks), you can stop taking it.
Taking pantoprazole just on days when you have symptoms is not suitable for everyone. Speak to your doctor about what’s best for you.
If you forget to take it
If you usually take pantoprazole:
- once a day – take the missed dose as soon as you remember, unless your next dose is due in less than 12 hours in which case skip the missed dose and take the next one at the usual time
- twice a day – take the missed dose as soon as you remember, unless your next dose is due in less than 4 hours in which case skip the missed dose and take the next one at the usual time
Never take a double dose to make up for a forgotten one.
If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to remember to take your medicine.
If you take too much
It is very unlikely that taking extra doses of pantoprazole will cause any problems. But if you’re concerned, contact your doctor.
5. Side effects
Most people who take pantoprazole do not have any side effects. If you do get a side effect, it is usually mild and will go away when you stop taking pantoprazole.
These side effects happen in 1 in 100 people. Talk to your pharmacist or doctor if these side effects bother you or do not go away:
- headaches
- diarrhoea
Serious side effects
Serious side effects are rare and happen in less than 1 in 1,000 people.
Call a doctor or contact 111 straight away if you have:
- joint pain along with a red skin rash, especially on parts of your body exposed to the sun, such as your arms, cheeks and nose (this may be less noticeable on brown or black skin) – these can be signs of a rare condition called subacute cutaneous lupus erythematosus. This can happen even if you’ve been taking pantoprazole for a long time
- stomach pain that gets worse, the whites of your eyes turn yellow or your skin turns yellow (this may be less obvious on brown or black skin), or dark pee – these can be signs of liver problems
- pain when you pee, peeing less than usual, lower back pain, swollen ankles, and rash or a high temperature – these can be signs of a kidney problem
- severe or persistent diarrhoea – this can be a sign of an inflamed bowel
Go to 111. nhs.uk or call 111.
Serious allergic reaction
In rare cases, it’s possible to have a serious allergic reaction (anaphylaxis) to pantoprazole.
Immediate action required: Call 999 or go to A&E now if:
- you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
- you’re wheezing
- you get tightness in the chest or throat
- you have trouble breathing or talking
- your mouth, face, lips, tongue or throat start swelling
You could be having a serious allergic reaction and may need immediate treatment in hospital.
These are not all the side effects of pantoprazole. For a full list see the leaflet inside your medicine packet.
Information:
You can report any suspected side effect using the Yellow Card safety scheme.
Visit Yellow Card for further information.
6. How to cope with side effects of pantoprazole
What to do about:
- headaches – make sure you rest and drink plenty of fluids. It’s best not to drink too much alcohol. Ask your pharmacist to recommend a painkiller. Headaches usually go away after the first week of taking pantoprazole. Talk to your doctor if they last longer than a week or are severe.
- diarrhoea – drink plenty of water or squash by having small, frequent sips to avoid dehydration. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor. If diarrhoea does not get better, talk to your doctor.
7. Pregnancy and breastfeeding
Pantoprazole and pregnancy
Pantoprazole is not usually recommended if you’re pregnant because there is little information about its use during pregnancy. Your doctor may recommend a similar medicine called omeprazole instead as there is more safety information available.
You may wish to try to treat your symptoms without taking medicine. You can try eating smaller meals more often, and avoiding fatty and spicy foods. Sit up straight when you eat, as this will take the pressure off your stomach.
If you get symptoms at night, you could prop your head and shoulders up when you go to bed. This helps to stop stomach acid coming up while you sleep.
Pantoprazole and breastfeeding
If your doctor or health visitor says your baby is healthy, it’s OK to take pantoprazole while you’re breastfeeding.
There is a little information available which shows that pantoprazole passes into breast milk in tiny amounts and your baby will not absorb a lot into their body from the breast milk.
It is unlikely that pantoprazole will cause any side effects in your baby.
Non-urgent advice: Tell your doctor if you’re:
- trying to get pregnant
- pregnant
- breastfeeding
8. Cautions with other medicines
Some medicines and pantoprazole can affect each other and make you more likely to have side effects or stop one of the medicines working as well.
Tell your doctor if you’re taking any of these medicines before you start pantoprazole treatment:
- antifungal medicines such as itraconazole, ketoconazole, posaconazole and voriconazole
- fluvoxamine, an antidepressant
- methotrexate, a medicine used to treat cancer, psoriasis and rheumatoid arthritis
- HIV medicines
- rifampicin, an antibiotic
- medicines that hep to prevent blood clots, such as warfarin
Mixing pantoprazole with herbal remedies and supplements
Do not take St John’s wort, the herbal remedy for depression, while you’re taking pantoprazole. St John’s wort may stop pantoprazole working as well as it should.
There’s not enough information to say that other complementary medicines and herbal remedies are safe to take with pantoprazole. They’re not tested in the same way as pharmacy and prescription medicines. They’re generally not tested for the effect they have on other medicines.
Important:
Medicine safety
Tell your doctor or pharmacist if you’re taking any other medicines, including herbal medicines, vitamins or supplements.
9. Common questions about pantoprazole
How does pantoprazole work?
Pantoprazole is a type of medicine called a proton pump inhibitor (PPI).
Proton pumps are enzymes in the lining of your stomach that help it make acid to digest your food.
Pantoprazole prevents proton pumps from working properly. This reduces the amount of acid the stomach makes.
When will I feel better?
You should start to feel better within 2 to 3 days. It may take up to 4 weeks for pantoprazole to work properly so you may still have some symptoms during this time.
If you bought pantoprazole without a prescription, and feel no better after 2 weeks, tell your doctor. They may want to do tests or change you to a different medicine.
Can I take pantoprazole for a long time?
If you’ve bought pantoprazole from a pharmacy without a prescription, do not take it for more than 4 weeks without speaking to your doctor.
If you take pantoprazole for more than 3 months, the levels of magnesium in your blood may fall.
Low magnesium can make you feel tired, confused and dizzy and cause muscle twitches, shakiness and an irregular heartbeat. If you get any of these symptoms, tell your doctor.
Taking pantoprazole for more than a year may increase your chances of certain side effects, including:
- bone fractures
- gut infections
- vitamin B12 deficiency – symptoms include feeling very tired, a sore and red tongue, mouth ulcers and pins and needles
If you take pantoprazole for longer than 1 year your doctor will regularly check your health to see if you should carry on taking it.
It’s not known if pantoprazole works less well the longer you take it. If you feel that it’s not working any more, talk to your doctor.
Does taking pantoprazole for a long time cause stomach cancer?
There is some information to suggest people taking medicines that reduce stomach acid, like proton pump inhibitors (PPIs) such as pantoprazole and h3 blockers, might have a very small increased chance of developing stomach cancer. It could be more likely in people taking them for longer than 3 years.
But studies involving more people need to be done to be sure that PPIs and h3 blockers cause stomach cancer, rather than something else causing it.
PPIs, like most medicines, can have side effects so it’s best to take them for the shortest time possible.
And it’s important to speak to your doctor if you notice any of these symptoms which can be signs of stomach cancer:
- having problems swallowing (dysphagia)
- feeling or being sick
- feeling full very quickly when eating
- losing weight without trying to
Speak to your doctor or pharmacist if you’re concerned.
How do I stop taking pantoprazole?
Usually, you can stop taking pantoprazole without reducing the dose first.
But if you’ve taken pantoprazole for a long time, speak to your doctor before you stop taking it. Stopping suddenly could make your stomach produce a lot more acid, and make your symptoms come back.
Reducing the dose gradually before stopping completely will prevent this happening.
Are there similar medicines?
There are 4 other medicines that are similar to pantoprazole:
- lansoprazole
- omeprazole
- esomeprazole
- rabeprazole
Like pantoprazole, these medicines are proton pump inhibitors. They work in the same way to reduce acid in your stomach. They generally work as well as pantoprazole and have similar side effects. However, they may be given in different doses to pantoprazole.
Sometimes, if pantoprazole is not working for you or you get side effects, your doctor may suggest that you try taking another proton pump inhibitor.
Are there other indigestion medicines?
There are other prescription medicines and ones you can buy that treat indigestion and heartburn.
Antacids
Antacids, like calcium carbonate (Tums), sodium bicarbonate, Maalox and Milk of Magnesia, relieve indigestion and heartburn by reducing the damage of acid in your stomach. They give quick relief that lasts for a few hours. They’re ideal for occasional stomach acid symptoms.
Some antacids, such as Gaviscon, have an extra ingredient called alginic acid. They work by lining your stomach so that juices from it do not splash up into your food pipe. They’re especially good for relieving acid reflux.
Antacids are available from pharmacies and supermarkets.
h3 blockers
Histamine antagonists (commonly called h3 blockers) reduce the amount of acid made in your stomach, but they do this in a different way to proton pump inhibitors.
They include famotidine (Pepcid), cimetidine (Tagamet) and nizatidine.
In general, proton pump inhibitors like pantoprazole are used first because they are better than h3 blockers at reducing stomach acid.
However, if a proton pump inhibitor does not suit you (for example, because of side effects), your doctor may prescribe an h3 blocker.
You can buy famotidine and nizatidine without a prescription from pharmacies.
Can I take pantoprazole with an antacid?
You can take pantoprazole with an antacid like Gaviscon.
Can I take painkillers with it?
Yes, it’s safe to take painkillers such as paracetamol or ibuprofen at the same time as pantoprazole.
It’s best to take ibuprofen with, or just after, a meal so it does not upset your stomach.
Will it affect my fertility?
There’s no evidence to suggest that taking pantoprazole will reduce fertility in either men or women.
However, speak to a pharmacist or your doctor if you’re trying to get pregnant as they may want to review your treatment.
Will it affect my contraception?
Pantoprazole does not affect any type of regular contraception, including the combined pill. But it may reduce the effectiveness of one type of emergency contraception called ellaOne (ulipristal), so a different form of emergency contraceptive may be recommended instead.
If pantoprazole gives you severe diarrhoea for more than 24 hours, your contraceptive pills may not protect you from pregnancy. Check the pill packet to find out what to do.
Find out what to do if you’re on the pill and have diarrhoea.
Can I drive or ride a bike?
Pantoprazole can make you feel dizzy or sleepy, or affect your vision. If this happens to you, do not drive, cycle or use machinery or tools until you feel better.
It’s an offence to drive a car if your ability to drive safely is affected. It’s your responsibility to decide if it’s safe to drive. If you’re in any doubt, do not drive.
Talk to your doctor or pharmacist if you’re unsure whether it’s safe for you to drive while taking pantoprazole. GOV.UK has more information on the law on drugs and driving.
Is there any food or drink I need to avoid?
You can eat and drink normally while taking pantoprazole, but it’s best to take it an hour before a meal.
It’s best to avoid foods that seem to make your symptoms worse, such as rich, spicy and fatty foods. It also helps to cut down on caffeinated drinks, such as tea, coffee and cola, as well as alcohol.
Can I drink alcohol with it?
Alcohol does not affect the way pantoprazole works. However, it’s best not to drink too much alcohol because drinking alcohol makes your stomach produce more acid than normal. This can irritate your stomach lining and make your symptoms worse.
Can lifestyle changes help?
It may be possible to ease symptoms caused by too much stomach acid by making a few changes to your diet and lifestyle.
- Maintain a healthy weight by eating healthily.
- Avoid foods that can make your symptoms worse, such as rich, spicy and fatty foods, and acidic foods like tomatoes, citrus fruits, salad dressings and fizzy drinks.
- Cut down on caffeinated drinks, such as tea, coffee and cola.
- Cut down on alcohol.
- Quit smoking if you can.
- Sit up straight when you eat. This will take the pressure off your stomach.
- If you have symptoms at night, try not to eat for at least 3 hours before you go to bed.
- Prop your head and shoulders up when you go to bed.
This can stop stomach acid coming up while you sleep.
Effectiveness, Ease of Use, and Satisfaction
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Most voted positive review
54 People found this comment helpful
I have had very good results with this medication. I am a crohn’s disease patient and so also get duodenal ulcers and have had a GI hemorrhage which was also treated with pantoprazole. I am also a practical Nurse with 20yrs experience. One thing I would like to address is the comments regarding the generic versions of the medication. A generic MUST have exactly the same medicinal ingredient as…
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Most voted negative review
6 People found this comment helpful
Was given this generic medication instead of name brand protonix. It is not effective at all for my symptoms! After a weeks use all my symptoms are back! Burning pain. Would leave no stars but would not let me. I have used protonix for last 5 years with no symptoms!
Shared reviews and ratings
SORT BY Condition: Excessive Production of Stomach Acid
Overall rating 4.3
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After taking this drug for a long period of time it started making my chest hurt and I felt like my food wasn’t going down well. I stopped taking it and asked my Gastroenterologists for something else. He told me to take 20 mg of pepcid over the counter. It was as if he was angry that I asked for something else. So i asked my primary physician to prescribe something else and he gave me 40 mg of Famotidine. I felt like that was too much so I’m now takings 20 mg of Famotidine and its working better for me. I can get this through my prescription drug company at no cost to me. It’s the same thing as 20 mg of pepcid just the generic brand and I don’t have to pay for it.
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Fill 3Created with Sketch. Condition: Inflammation of the Esophagus with Erosion
Overall rating 1.7
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I have had GERD, ulcers and esophagitis issues for decades. Loved Zantac and nexium but don’t want to take anything too long due to osteoporosis. After last endoscopy doctor wanted me to try Protonix. I was excited because I had not heard of it. I’ve been on it for seven days. Within two days of taking it i had headaches and diarrhea so bad all day I thought I was prepping for another colonoscopy. Then came the stomach cramps and dizziness and chills. Even with all the diarrhea I am so bloated my sweats are so tight. This is only seven days. GERD is still horrible. I never had any of these problems with the nexium so I guess I’ll go back to that or just use the sulfacrate by itself.Read More Read Less
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Fill 3Created with Sketch. Condition: Conditions of Excess Stomach Acid Secretion
Overall rating 4.7
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Pantoprazole has been my savior for Gastritis. 40mg was given to me morning and night when I was at my worst in the hospital, then I titrated down to 20mg morning and night. Eventually and only took it once a day and took Pepcid AC 10mg twice a day to replace the second dose. I’ve had two side effects that are negative from Pantoprazole, after taking it for 3 months my hair starts to fall out. This has happened twice and is a direct correlation to the Pantoprazole. Also, it makes my skin dry, and flaky. I eventually have to completely come off it and give my body a break. After 3 months off it, my stomach problems start again and I have to retake it. Its not a fun cycle. Trying to heal my stomach with all kinds of things. Mostly my stress is causing the recurrence of Gastritis though. Anyway, it works, but beware of the hair loss and the dry skin, my ear lobs even cracked open at the joint of my neck. All sides totally go away within 4-6 weeks of quitting.
43 yr old healthy male, (other than the gastritis and anxiety/stress lol.) Read More Read Less
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Fill 3Created with Sketch. Condition: Other
Overall rating 5.0
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I had to esophageal cancer and had my esophagus removed. I’ve been on this medication for over 5 years now at 40 mg a day and have had no ill effects.
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Fill 3Created with Sketch. Condition: Indigestion
Overall rating 1.0
EffectivenessEase of UseSatisfaction
DO NOT TAKE THIS MEDICINE! IT’S COMPLETE POISON.
What’s up this medicine for one month 40 mg twice a day for indigestion. An hour after I took this medication I became extremely light-headed and dizzy. Joint aches all over, anxiety through the roof. Had blood test, brain scans, endoscopies, colonoscopies they couldn’t figure out what it was. Stopped taking it and felt better after 2 days. THIS MEDICATION IS POISON!
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Fill 3Created with Sketch. Condition: Inflammation of the Stomach Lining caused by H. Pylori
Overall rating 1.0
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I had bad pains in my stomach. I went to the dr and she prescribed me pantoprazole 40mg. Day 1 I took it in the AM before breakfast. The stomach pain instantly went away. I was like thank God! Day2 I started feeling like I was having heat waves come over me. I couldn’t sleep at night. I had a slight headache when I woke up. Didn’t think anything of it. Day3 more heat waves with a feeling of panic. Another night of no sleep. My stomach felt great. So I continued to take it. I made it to day 7. I had a horrible night!! Full of panic attacks, sweating, diarrhea, chills. I had to cancel my flight out of the country. As I was sweating and panicking on the couch while everyone was asleep. I looked up the reviews on this med. Then realized it was the side effects. I got up and chunked it in the trash! All day I felt exhausted, panicky, and depressed from everything. I called my dr and told her. She acted like she never heard of it. I told her to go google it! DONT TAKE THIS DRUG!!! Read More Read Less
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Fill 3Created with Sketch. Condition: Conditions of Excess Stomach Acid Secretion
Overall rating 1.0
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I was diagnosed with silent reflux and was on omeprazole for 3 months in 2019. I improved my diet and stopped drinking coffee and it healed quickly. I had no issues with the omeprazole. Last year I lost two close relatives and wasn’t sleeping, so I started on coffee again, one cup a day. Four weeks ago, my burning mouth syndrome started up- burning sensation in palate- which I first experienced in 2011. My ENT prescribed omeprazole 40 mg after an endoscopy. I this time I started having side effects – brain fog, feeling unwell and extreme sensitivity of my teeth. After 3 weeks, she switched me to pantoprazole. I started experiencing neck pain, still had teeth sensitivity and felt tired and sick. I started taking 20 mg omeprazole today to wean off everything. I will call my ENT tomorrow, but I will not go back on those meds. My burning mouth has improved, so hopefully the symptoms from the PPIs will resolve. Read More Read Less
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Fill 3Created with Sketch. Condition: Increased Stomach Acid from Systemic Mastocytosis
Overall rating 5.0
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been using this drug for 2 months works very very well.
1
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Fill 3Created with Sketch. Condition: Inflammation of the Esophagus with Erosion
Overall rating 1.7
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I started ok the reflux was gone, but things started to go wrong at about week 5. I was choking and panicking then came pain in my joints went to the doctor he said it was in my head on week 10.
I had the feeling death was better than this. I will never take meds again
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Fill 3Created with Sketch. Condition: Inflammation of the Esophagus with Erosion
Overall rating 2.7
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Would not recommend to anyone with current mental health issues. Experience horrible anxiety and irritability that oddly set in after starting it. Further, I felt as though everything I ate sat like a rock and caused bad constipation. Lower dosage helped the constipation, but anxiety/worry did not subside and GERD symptoms increased.
1
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Fill 3Created with Sketch. Condition: Heartburn
Overall rating 1.0
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Doctor changed me from Omeprazole 20 mg to Pantoprazole 40 mg. I feel horrible. Terrible heartburn, chest pain, burping, nausea. Going back to Omeprazole and will take 40 mg to try and manage GERD. Against my better judgement since all of these PPI’s aren’t good for you and I believe I actually have low stomach acid as a result of taking these drugs for 15 years. Also have been diagnosed with SIBO likely because of PPI’s. Will be discussing with doctor and would advise anyone to be careful when taking PPI’s. Read More Read Less
1
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Fill 3Created with Sketch. Condition: Other
Overall rating 5.0
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No heartburn at all with PANTOPRAZOLE SOD DR 40 mg
And no side effects 5 Stars
1
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Fill 3Created with Sketch. Condition: Condition in which Stomach Acid is Pushed Into the Esophagus
Overall rating 4.7
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Bad cough from stomach acid working over my esophagus. This medication started working almost immediately. Once I lose weight (my biggest problem) I’ll stop using it.
1
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Fill 3Created with Sketch. Condition: Heartburn
Overall rating 1.7
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I was on Pantoprazole 40 mg for 2 years. During it seemed to work but I noticed my joints always ached, my ankles were swollen, I had constant diarrhea, heart palpitations, blurred vision and the list goes on. About 6 months ago, I started having severe anxiety/panic attacks. I noticed this would only happen when I took the medicine. I stopped the medicine cold Turkey. I no longer have joint pain, my ankles are not swollen and I have normal bowels. However, my anxiety has not stopped. This medication will leave you in a condition worse than what you started with. I will never take it again! Read More Read Less
1
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Fill 3Created with Sketch. Condition: Indigestion
Overall rating 2.3
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I had some stomach pain due to some food I ate and decided to go to the doctor to check just in case and he subscribed me pantoprazole 40mg.
I started to take it next day in the morning and by the end of that day I had a bit of headache which I thought it was due to the fact that I ate very little. Next morning I woke up with a headache again and took a paracetamol but around noon it got worse, so I took some ibuprofen. Next day I woke up quite well but just as I was driving my wife to work I felt something wrong. I came back home, had a nap, was feeling a little better and went on with my day. Around 2pm I was driving when the my hands started to get cold, my heart started racing and my anxiety was sky high. I could barely drive my way back home safely. I got home, tried to rest, but the anxiety, mental confusion and sort of desperation didn’t go. At some point I decided to have a shower and see if that would help and during the shower occur to me that this could be a side effect of this crap, and after reading the papers and some reviews, sure enough it was.
I stopped the thing right away and still took me good 4 days to recover. The side effects of this S**t was way worse than the issue I had that lead me to take it.
Never again!!!Read More Read Less
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Fill 3Created with Sketch. Condition: Inflammation of the Esophagus with Erosion
Overall rating 1.7
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Severe irritability. So bad that I thought I was losing my mind. This medicine was total s**t for me. Plus the anxiety from thinking I was losing my mind caused SO much more acid that the GERD got worse. This “medicine” almost drove me to suicide.
1
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Fill 3Created with Sketch. Condition: Condition in which Stomach Acid is Pushed Into the Esophagus
Overall rating 4.3
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started gaining weight 3 or 4 lbs a month went from 220 to 255 in five month
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Fill 3Created with Sketch. Condition: Condition in which Stomach Acid is Pushed Into the Esophagus
Overall rating 1.7
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After being on this medication for a period of time I developed a heart condition that may be related to this medication
1
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Fill 3Created with Sketch. Condition: Other
Overall rating 4.3
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Gastritis. I was diagnosed with Gastritis and ibs and celiac disease. I cut out all gluten, and changed my diet to a nothing below a ph of 5 diet (low acid, more alkaline diet). Still was having stomach bloating and burning. Was put on 40mg once a day of Pantoprazole. Started to help immediately with the bloating and burning. Within a couple weeks I started having some skin issues, ear lobes were cracking, arms were flaking and dry. But I didn’t want to stop taking it because it really helped my stomach. I could tell it was healing finally. So I asked to cut the dose. New script of 20mg a day, and I put aloe on my skin everyday and I’m good. Ear lobes are normal again, my skin is dry but after pure aloe off of Amazon it’s fine all day. I use dove soap when I shower so it dosent dry my skin to bad, and I’m making it work, I’ve tried Pepcid AC, didn’t do anything for stomach hit gave me heart palpitations. Try Nexium, made me crazy, and depressed. Pantoprazole dosent affect me mentally, and it works on my stomach. Not more bloat. I can deal with putting on lotion once a day to be able to eat again. Don’t listen to all the bad reviews, eveyone is different. Most people won’t leave a good review when a med works. They are just happy the problem is fixed and they forget about it and go back to their lives Read More Read Less
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Fill 3Created with Sketch. Condition: Excessive Production of Stomach Acid
Overall rating 1.7
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I had basically eliminated my reflux when I bought an adjustable bed. My Dr. Wanted me to take this as a precaution against esophageal swelling. After a week of this drug I had worse reflux than I ever had. I read reviews on it and most people were having problems so I stopped taking it. A month later and I still have throat pain from acids. I’m worried it won’t go away. Please consider the risks before taking this drug.
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What is prescribed for, side effects
According to doctors, diseases of the digestive system are diseases of civilization. Each person at least once faced such manifestations as abdominal pain, heartburn, belching, bloating, nausea, vomiting, diarrhea, constipation. Gastrointestinal diseases in terms of the number of hospitalizations rank third after pregnancy and cardiovascular diseases.
According to clinical guidelines in the complex therapy of gastric ulcers and gastroesophageal reflux disease (GERD), drugs from the PPI group – proton pump inhibitors are used. Using the example of the drug Pantoprazole, we analyze how such drugs “work” in the body, what they help with and what side effects they have. Compare Pantoprazole with Omeprazole, Rabeprazole and Nolpaza.
Pantoprazole: what helps
Hydrochloric acid, contained in gastric juice, stimulates the production of digestive enzymes, activates gastric motility and destroys pathogens that come with food. It is produced in the parietal cells of the gastric mucosa, and the proton pump enzyme controls this process.
Excessive secretion of hydrochloric acid is dangerous for the mucous membrane of the esophagus, stomach and duodenum. To reduce its production, Pantoprazole is prescribed, which blocks the action of the proton pump and reduces the aggressive effect of gastric juice on the gastrointestinal mucosa.
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Pantoprazole What is it used for
What is Pantoprazole used for? Under what diseases and conditions is it necessary to reduce the secretion of hydrochloric acid? Before answering the questions, we clarify that the indications for the use of the drug depend on the dosage. Pantoprazole tablets are produced in two types:
1. Pantoprazole 20 mg is indicated for the relief of heartburn and regurgitation in GERD in adults. The drug reduces the aggressiveness of gastric juice, which is thrown into the esophagus and prevents the formation of erosion, ulcers and burns.
2. Pantoprazole 40 mg tablets are used for:
- exacerbation of gastric and duodenal ulcers to allow it to heal;
- erosive gastritis, including those associated with the use of non-steroidal anti-inflammatory drugs, to protect the mucous membrane;
- complex eradication of the bacterium Helicobacter pylori, which becomes more sensitive to antibiotics at elevated pH;
- Zollinger-Ellison syndrome to prevent the formation of erosions and ulcers.
Pantoprazole: side effects
If the drug is used according to indications and in accordance with the instructions, side effects are rare. Headache and diarrhea were reported in only 1% of patients. Also possible:
- dizziness;
- benign polyps of gastric glands;
- bloating, constipation;
- dry mouth, nausea, vomiting;
- abdominal pain and discomfort;
- dermatitis, pruritus, rash;
- fractures.
Pantoprazole or Omeprazole: which is better?
Omeprazole is the first and most studied proton pump inhibitor. Indications for use are generally similar to those of Pantoprazole. The main difference is that omeprazole at a dose of 20 mg is approved for the treatment of children from 2 years of age with GERD and from 4 years of age in the eradication of Helicobacter pylori, and Pantoprazole is indicated only for adult patients from 18 years of age.
Preparations differ in the form of release. Omeprazole is produced in the form of microcapsules enclosed in an enteric shell and placed in a capsule. Pantoprazole is an enteric coated tablet. Omeprazole capsules can be dissolved in acidified water, juice or fruit puree. In this form, they are convenient for children and patients with difficulty swallowing.
Omeprazole is more likely than Pantoprazole to cause headache, drowsiness, lethargy and gastrointestinal side effects, has more interactions with other drugs with antacids. But, despite the similarity of action, patients should not independently decide what to take – Omeprazole or Pantoprazole. To do this, you need to consult a doctor, as the drugs have differences.
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11 reviews
Pantoprazole or Rabeprazole: which is better?
Rabeprazole is also a PPI and has a number of advantages over Pantoprazole: it works up to 48 hours, it is allowed for children from 12 years old with GERD at a dosage of 20 mg, it can be used regardless of food intake.
Another “positive” difference of Rabeprazole is that it is active at almost any pH of gastric juice, while Pantoprazole is active only at pH not higher than 3.
Preparations contain different active and excipients, have their own characteristics of purpose, so the choice of Pantoprazole or Rabeprazole is made by the attending physician.
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10 reviews
Pantoprazole or Nolpaza: which is better?
Under the name Pantoprazole, the drug is produced by Russian companies, and Nolpaza is an analogue of the Slovenian company KRKA. Pantoprazole and Nolpaza are complete analogues with the same active ingredient. They differ in manufacturers, excipients and the place of synthesis of substances. So, pantoprazole for Nolpaza is produced in Slovenia, and for Pantoprazole – in Spain and India.
According to the instructions for medical use, Nolpaza is approved for the treatment of children from 12 years of age. Therefore, the drug has an advantage in pediatric practice. In other cases, Nolpaza and Pantoprazole are interchangeable, taking into account the dosages prescribed by the doctor and the appointment.
It should be remembered that when taking any proton pump inhibitors, the risk of developing osteoporosis and certain gastrointestinal infections increases. If PPIs are prescribed, then other drugs that reduce the acidity of gastric juice should not be taken.
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20 reviews
Summary
- Pantoprazole blocks the action of the proton pump enzyme, reduces the production of hydrochloric acid and reduces the aggressive effect of gastric juice on the gastrointestinal mucosa.
- Pantoprazole is indicated for the treatment of GERD, gastric and duodenal ulcers, erosive gastritis and Zollinger-Ellison syndrome.
- If the drug is used according to indications and in accordance with the instructions, then side effects are rare.
- The main difference is that omeprazole at a dose of 20 mg is approved for the treatment of children from 2 years of age with GERD and from 4 years of age in the eradication of Helicobacter pylori, and Pantoprazole is indicated only for adult patients from 18 years of age.
- Rabeprazole is active at almost any pH of gastric juice, while Pantoprazole is active only at pH not higher than 3.
- According to the instructions for medical use, Nolpaza is approved for the treatment of children from 12 years of age. Therefore, the drug has an advantage in pediatric practice.
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Pantoprazole-Teva: instruction, price, analogues | gastroresistant tablets Teva Ukraine
- Pharmacological properties
- Indications Pantoprazole-Teva
- Application of Pantoprazole-Teva
- Contraindications
- Side effects
- Special instructions
- Interactions
- Overdose
- Storage conditions
- Diagnosis
- Recommended alternatives
- Trade names
pharmacodynamics . Pantoprazole is a substituted benzimidazole that inhibits gastric acid secretion by specific blockade of the parietal cell proton pump. Pantoprazole is converted to its active form in an acidic environment in parietal cells, where it inhibits the H 9 enzyme.0133 + -K + -ATPase, that is, it blocks the final stage of hydrochloric acid production in the stomach. Inhibition is dose-dependent; pantoprazole inhibits both basal and stimulated acid secretion. In most patients, symptoms disappear within 2 weeks. When using pantoprazole, as in the case of other proton pump inhibitors (PPIs) and inhibitors of H 2 receptors, acidity in the stomach decreases and thus gastrin secretion increases in proportion to the decrease in acidity. The increase in gastrin secretion is reversible. Since pantoprazole binds the enzyme distally to the cellular receptor, it can inhibit the secretion of hydrochloric acid, regardless of stimulation by other substances (acetylcholine, histamine, gastrin).
The effect of oral and / in the use of the drug is the same.
Pantoprazole increases fasting gastrin levels. With short-term use of the drug, the level of gastrin in most cases does not exceed the upper limit of normal. With long-term treatment, the level of gastrin in most cases doubles. Excessive increase, however, occurs only in isolated cases. As a consequence, a slight to moderate increase in specific enterochromaffin-like (ECL) cells in the stomach (similar to adenomatoid hyperplasia) is sometimes noted during long-term treatment. However, according to studies conducted to date, the formation of cells – precursors of neuroendocrine tumors (atypical hyperplasia) or neuroendocrine tumors of the stomach, identified in animal experiments, has not been observed in humans.
Based on the results of animal studies, the effect of long-term (more than 1 year) treatment with pantoprazole on thyroid endocrine parameters cannot be ruled out.
During treatment with antisecretory drugs, the level of gastrin in the blood serum increases in response to a decrease in acid secretion. In addition, chromogranin A (CgA) levels increase due to a decrease in stomach acidity. Elevated levels of CgA may affect the results of studies in the diagnosis of neuroendocrine tumors. Available published data suggest that PPI treatment should be discontinued within 5 days to 2 weeks prior to CgA measurements. This allows the CgA level to return to the range of normal values that may be erroneously elevated after PPI treatment.
Pharmacokinetics . Suction . Pantoprazole is rapidly absorbed, and C max in plasma is achieved after a single oral dose of 40 mg. On average, 2.5 hours after ingestion, C max is reached in the blood serum at a level of about 2–3 μg / ml, the concentration remains constant after repeated administration. Pharmacokinetic properties do not change after a single or repeated administration. In the dose range of 10–80 mg, the pharmacokinetics of pantoprazole in blood plasma remains linear both when administered orally and intravenously. Simultaneous food intake does not affect AUC (area under the concentration-time curve) or C max in serum and, accordingly, on bioavailability. With the simultaneous intake of food, only the variability of the latent period increases.
Distribution . The binding of pantoprazole to serum proteins is about 98%. The volume of distribution is about 0.15 l / kg.
Biotransformation . The substance is metabolized almost exclusively in the liver. The main metabolic pathway is demethylation by CYP 2C19 followed by sulfate conjugation; other metabolic pathways include oxidation by CYP 3A4.
Derivation of . The final T ½ is about 1 hour, and the clearance is 0.1 l / h / kg. Several cases of delayed excretion have been noted. Due to the specific binding of pantoprazole to the proton pump of parietal cells, T ½ does not correspond to a much longer duration of action (inhibition of acid secretion).
The main part of pantoprazole metabolites is excreted in the urine (about 80%), the rest – with feces. The main metabolite in both serum and urine is desmethylpantoprazole conjugated with sulfate. T ½ of the main metabolite (about 1.5 hours) is not much higher than T ½ of pantoprazole.
Special patient groups
Slow metabolisers . About 3% of Europeans have a need for a functionally active CYP 2C19 enzyme; they are called slow metabolizers. In such individuals, the metabolism of pantoprazole is probably mainly catalyzed by the CYP3A4 enzyme. After taking a single dose of 40 mg pantoprazole, the mean AUC was approximately 6 times greater in slow metabolizers than in individuals with a functionally active CYP 2C19 enzyme.(fast metabolizers). C max in blood plasma increased by about 60%. These results do not affect the dosage of pantoprazole.
Impaired renal function . There are no recommendations for dose reduction when prescribing pantoprazole to patients with impaired renal function (including dialysis patients). As in healthy people, T ½ of pantoprazole is short. Only a very small amount of pantoprazole is dialyzed. Despite the fact that the main metabolite has a moderately long T ½ (2-3 hours), elimination is still fast, so no cumulation occurs.
Impaired liver function . Although in patients with liver cirrhosis (classes A and B on the Child-Pugh scale) T ½ increases to 3-6 hours, and AUC – 3-5 times, C max in blood serum increases slightly – 1, 5 times compared to healthy volunteers.
Elderly patients . A slight increase in AUC and C max in elderly volunteers compared with the corresponding values in younger volunteers also has no clinical significance.
Children . After a single dose of 20 or 40 mg of pantoprazole orally, AUC and C max in children aged 5-16 years were within the corresponding values in adults. After a single intravenous administration of pantoprazole at a dose of 0. 8 or 1.6 mg/kg of body weight to children aged 2–16 years, there was no significant relationship between the clearance of pantoprazole and the age or body weight of the patient. AUC and V d were consistent with data from studies involving adults.
adults and children over 12 years of age:
– reflux esophagitis.
Adults:
– eradication of Helicobacter pylori in patients with H. pylori -associated gastric and duodenal ulcers in combination with appropriate antibiotics;
– duodenal ulcer;
– stomach ulcer;
– Zollinger-Ellison syndrome and other hypersecretory pathological conditions.
Pantoprazole-Teva gastro-resistant tablets should be taken whole 1 hour before meals, not chewed or crushed, with plenty of water.
Recommended treatment
Adults and children over 12 years of age . Treatment of reflux esophagitis . The recommended dose is 1 tablet of Pantoprazole-Teva 40 mg once a day. In some cases, the dose can be doubled (2 tablets of Pantoprazole-Teva 40 mg / day), especially in the absence of the effect of the use of other drugs for the treatment of reflux esophagitis. Reflux esophagitis usually takes 4 weeks to heal. If this is not enough, a cure can be expected within the next 4 weeks.
Adults . Eradication H. pylori in combination with two antibiotics . In adult patients with gastric and duodenal ulcers and positive for H. pylori , it is necessary to achieve eradication of the microorganism using combination therapy. Local data on bacterial resistance and national guidelines for the use and administration of appropriate antibacterial agents should be taken into account. Based on susceptibility for eradication H. pylori in adults, the following therapeutic combinations can be prescribed:
a) 1 tablet of Pantoprazole-Teva 40 mg 2 times a day + 1000 mg of amoxicillin 2 times a day + 500 mg of clarithromycin 2 times a day;
b) 1 tablet of Pantoprazole-Teva 40 mg 2 times a day + 400-500 mg of metronidazole (or 500 mg of tinidazole) 2 times a day + 250-500 mg of clarithromycin 2 times a day;
c) 1 tablet of Pantoprazole-Teva 40 mg 2 times a day + 1000 mg of amoxicillin 2 times a day + 400–500 mg of metronidazole (or 500 mg of tinidazole) 2 times a day.
When using combination therapy for the eradication of H. pylori , the second tablet of Pantoprazole-Teva 40 mg should be taken in the evening 1 hour before meals. The duration of treatment is 7 days and can be extended for another 7 days with a total duration of treatment of not more than 2 weeks. If further treatment with pantoprazole is indicated to ensure ulcer healing, dosing recommendations for gastric and duodenal ulcers should be considered. If combination therapy is not indicated, for example, patients who are negative at H. pylori , for monotherapy, Pantoprazole-Teva 40 mg is used at the following dose.
Treatment of stomach ulcers . 1 tablet of Pantoprazole-Teva 40 mg per day. In some cases, the dose can be doubled (2 tablets of Pantoprazole-Teva 40 mg per day), especially if there is no effect from the use of other drugs.
Gastric ulcer usually takes 4 weeks to heal. If this is not enough, healing of the ulcer can be expected within the next 4 weeks.
Treatment of duodenal ulcer . 1 tablet of Pantoprazole-Teva 40 mg per day. In some cases, the dose can be doubled (2 tablets of Pantoprazole-Teva 40 mg per day), especially if there is no effect from the use of other drugs.
Duodenal ulcer usually takes 2 weeks to heal. If this is not enough, healing of the ulcer can be expected within the next 2 weeks.
Treatment of Zollinger-Ellison syndrome and other hypersecretory pathological conditions . For long-term treatment of Zollinger-Ellison syndrome and other pathological hypersecretory conditions, the initial daily dose is 80 mg (2 tablets of Pantoprazole-Teva 40 mg each). If necessary, after this, the dose can be titrated, increasing or decreasing, depending on the acidity of the gastric juice. A dose exceeding 80 mg/day should be divided into 2 doses. A temporary increase in dose to more than 160 mg of pantoprazole is possible, but the duration of use should be limited only to the period necessary for adequate control of acidity.
The duration of treatment for Zollinger-Ellison syndrome and other pathological conditions is not limited and depends on clinical need.
Special patient groups
Patients with hepatic impairment . Patients with severely impaired liver function should not exceed a daily dose of 20 mg (1 tablet of Pantoprazole-Teva 20 mg). Pantoprazole-Teva should not be used for the eradication of H. pylori as part of combination therapy in patients with moderate to severe hepatic impairment, since there are currently no data on the efficacy and safety of such use in this category of patients.
Patients with impaired renal function . For patients with impaired renal function, dose adjustment is not required. Patients with impaired renal function should not use Pantoprazole-Teva for the eradication of H. pylori in combination therapy, since there are currently no data on the efficacy and safety of such use for this category of patients.
For elderly patients dose adjustment is not required.
hypersensitivity to pantoprazole, benzimidazole derivatives or any component of the drug.
The most common adverse reactions are diarrhea and headache.
on the part of the blood and lymphatic system: agranulocytosis, leukopenia, thrombocytopenia, pancytopenia.
From the immune system: hypersensitivity reactions (including anaphylactic reactions, anaphylactic shock).
Metabolism and metabolic disorders: hyperlipidemia and increased lipid levels (TG, cholesterol), changes in body weight, hyponatremia, hypomagnesemia (see SPECIAL INSTRUCTIONS), hypocalcemia (simultaneously with hypomagnesemia), hypokalemia.
Mental disorders: sleep disturbance, depression (including exacerbation), disorientation (including exacerbation), hallucinations, confusion (especially in patients with a predisposition to these disorders, as well as exacerbation of these symptoms, if any).
From the nervous system: headache, dizziness, taste disturbances, paresthesia.
On the part of the organ of vision: blurred vision / blurring.
From the gastrointestinal tract: glandular polyps of the fundus of the stomach (benign), diarrhea, nausea, vomiting, bloating, constipation, dry mouth, pain and discomfort in the abdomen.
From the hepatobiliary system: increased levels of liver enzymes (transaminases, gamma-glutamyl transferase), increased bilirubin levels, hepatocyte damage, jaundice, hepatocellular insufficiency.
From the skin and subcutaneous tissues: skin rash, exanthema, pruritus, urticaria, angioedema, Stevens-Johnson syndrome, Lyell’s syndrome, erythema multiforme, photosensitivity, subacute cutaneous lupus erythematosus (see SPECIAL INSTRUCTIONS).
From the musculoskeletal system and connective tissue: fractures of the hip, wrist or spine (see SPECIAL INSTRUCTIONS), arthralgia, myalgia, muscle spasm as a result of electrolyte disturbances.
From the side of the kidneys and urinary system: interstitial nephritis (with possible development of renal failure).
From the reproductive system and mammary glands: gynecomastia.
General violations: asthenia, fatigue, malaise, fever, peripheral edema.
liver dysfunction . Patients with severely impaired liver function should regularly monitor the level of liver enzymes, especially with long-term treatment. In the event of an increase in the level of liver enzymes, treatment with the drug must be discontinued (see APPLICATION).
Combination therapy . During combination therapy, the instructions for use of the respective medicinal products must be followed.
Malignant neoplasms of the stomach . Symptomatic response to the use of pantoprazole may mask the symptoms of malignant neoplasms of the stomach and delay their diagnosis in time. In the presence of alarming symptoms (for example, in the case of a significant decrease in body weight, periodic vomiting, dysphagia, vomiting with blood, anemia, melena), as well as in case of suspicion or presence of a stomach ulcer, the presence of a malignant process should be excluded. If symptoms persist with adequate treatment, additional testing is necessary.
HIV protease inhibitors . The simultaneous use of pantoprazole with HIV protease inhibitors (such as atazanavir), the absorption of which depends on intragastric pH, is not recommended due to a significant decrease in their bioavailability (see Interactions).
Vitamin B absorption 12 . In patients with Zollinger-Ellison syndrome and other hypersecretory pathological conditions who require long-term treatment, pantoprazole, like all drugs that block the production of hydrochloric acid, can reduce the absorption of vitamin B 12 (cyanocobalamin) due to hypo- and achlorhydria. This should be considered if patients are underweight or if there are risk factors for reduced vitamin B absorption with long-term treatment or if there are relevant clinical symptoms.
Long-term treatment . With prolonged treatment, especially more than 1 year, patients should be under regular medical supervision.
Bacterial gastrointestinal infections . Treatment with pantoprazole may slightly increase the risk of gastrointestinal infections caused by bacteria such as Salmonella and Campylobacter or C. difficile .
Hypomagnesemia . There have been cases of severe hypomagnesaemia in patients treated with PPIs such as pantoprazole for at least 3 months and in most cases for 1 year. The following serious clinical manifestations of hypomagnesaemia may occur and at first imperceptibly develop: fatigue, tetany, delirium, convulsions, dizziness and ventricular arrhythmia. With hypomagnesemia, in most cases, the condition of patients improved after replacement corrective therapy with magnesium preparations and discontinuation of PPIs.
Patients requiring long-term therapy or patients taking PPIs concomitantly with digoxin or drugs that can cause hypomagnesaemia (eg, diuretics) should have their magnesium levels checked before initiating PPI treatment and periodically during treatment.
Fractures of bones . Long-term treatment (more than 1 year) with high-dose PPIs may moderately increase the risk of hip, wrist, and spine fractures, predominantly in the elderly or in the presence of other risk factors. Observational studies indicate that the use of PPIs can increase the overall risk of fractures by 10–40%. Some of these may be due to other risk factors. Patients at risk of developing osteoporosis should be treated according to current clinical guidelines and should consume adequate amounts of vitamin D and calcium.
Subacute cutaneous lupus erythematosus . The use of PPIs has been associated with very rare cases of subacute cutaneous lupus erythematosus. If a lesion occurs, especially in areas exposed to sunlight, accompanied by arthralgia, the patient should immediately consult a doctor who will consider the need to discontinue the drug. The occurrence of subacute cutaneous lupus erythematosus in patients during prior PPI therapy may increase the risk of its development with other PPIs.
Effects on laboratory results . Elevated levels of chromogranin A (CgA) may affect the results of studies in the diagnosis of neuroendocrine tumors. To avoid such an effect, treatment with pantoprazole should be temporarily discontinued at least 5 days before the assessment of CgA levels. If CgA and gastrin levels have not returned to the normal range after the initial measurement, repeat measurements should be taken 14 days after stopping PPI treatment.
Use during pregnancy and lactation
Pregnancy . Experience with the use of pantoprazole in pregnant women is limited. Reproductive toxicity has been observed in animal studies. The potential risk to humans is unknown. Pantoprazole is used during pregnancy only if absolutely necessary.
Breastfeeding . Animal studies have shown excretion of pantoprazole into breast milk. There is evidence of the excretion of pantoprazole into human breast milk. The decision to continue/stop breastfeeding or continue/stop treatment with pantoprazole should be made taking into account the benefits of breastfeeding for the baby and the benefits of treatment for the woman.
The ability to influence the reaction rate when driving vehicles or operating other mechanisms . It is necessary to take into account the possible development of adverse reactions, such as dizziness and visual impairment. In such cases, you should not drive vehicles or work with other mechanisms.
Children . The drug is not recommended for use in children under the age of 12 years, since data on the safety and efficacy of the drug for this age group are limited.
medicinal products whose absorption depends on pH . As a result of complete and prolonged inhibition of hydrochloric acid secretion, pantoprazole may interfere with the absorption of drugs for which the gastric pH value is an important factor in their bioavailability (for example, some antifungal drugs such as ketoconazole, itraconazole, posaconazole, or other drugs such as erlotinib).
HIV protease inhibitors . The combined use of pantoprazole with HIV protease inhibitors (such as atazanavir), the absorption of which depends on intragastric pH, is not recommended due to a significant decrease in their bioavailability (see SPECIAL INSTRUCTIONS).
When concomitant use of HIV protease inhibitors with PPIs cannot be avoided, careful clinical monitoring (eg viral load) is recommended. Do not exceed a daily dose of pantoprazole of 20 mg. It may be necessary to adjust the dose of HIV protease inhibitors.
Coumarin anticoagulants (phenprocoumon and warfarin) . The combined use of pantoprazole with warfarin or phenprocoumon did not affect the pharmacokinetics of warfarin, phenprocoumon or international normalized ratio (INR). However, an increase in INR and a prolongation of prothrombin time have been reported in patients who simultaneously used PPIs and warfarin or phenprocoumon. An increase in INR and a prolongation of prothrombin time can lead to the development of pathological bleeding and even death. In the case of such combined use, it is necessary to monitor INR and prothrombin time.
Methotrexate . It has been reported that the simultaneous use of high doses of methotrexate (eg 300 mg) and PPIs increases blood levels of methotrexate in some patients. Patients taking high doses of methotrexate, such as patients with cancer or psoriasis, are advised to temporarily stop treatment with pantoprazole.
Other interactions . Pantoprazole is extensively metabolized in the liver through the cytochrome P450 enzyme system. The main metabolic pathway is demethylation by CYP 2C19and other metabolic pathways, including oxidation by CYP3A4. Studies with drugs that are also metabolized via these pathways, such as carbamazepine, diazepam, glibenclamide, nifedipine, and oral contraceptives containing levonorgestrel and ethinyl estradiol, did not reveal clinically significant interactions.
An interaction of pantoprazole with other drugs that are metabolized through the same enzyme system cannot be ruled out.
A number of potential interaction studies indicate that pantoprazole does not affect the metabolism of active substances that are metabolized by CYP 1A2 (eg caffeine, theophylline), CYP 2C9(eg piroxicam, diclofenac, naproxen), CYP 2D6 (eg metoprolol), CYP 2E1 (eg ethanol), does not affect p-glycoprotein, which is associated with digoxin absorption.
No interaction with concomitantly administered antacids.
Studies have been conducted to study the interaction of pantoprazole with concomitantly prescribed certain antibiotics (clarithromycin, metronidazole, amoxicillin). Clinically significant interactions between these drugs have not been identified.
Drugs that inhibit or induce CYP 2C19 . CYP2C19 inhibitors such as fluvoxamine may increase the systemic exposure to pantoprazole. The need to reduce the dose of the drug should be considered for patients who receive long-term therapy with pantoprazole in high doses, and for patients with impaired liver function. Enzyme inducers that affect CYP2C19 and CYP3A4, such as rifampicin and St. John’s wort (Hypericum perforatum), may decrease plasma concentrations of PPIs that are metabolized through these enzyme systems.
symptoms of overdose are unknown.
Doses up to 240 mg given intravenously over 2 minutes were well tolerated. Since pantoprazole is extensively protein-bound, it is not a drug that is readily eliminated by dialysis.